For the past three years, we have routinely used the one‐hour in vivo survival of 51Cr‐labeled donor red blood cells to select units for transfusion to patients for whom crossmatch compatible blood was unavailable. This technique successfully evaluated in vivo compatibility, thus avoiding acute hemolytic transfusion reactions in 38 problem patients. New or confirmatory data regarding the hemolytic potential of several well defined antibodies was also obtained. Antibodies which proved to be clinically insignificant included: anti‐IT (all IgG), anti‐Sda, anti‐Kir, Mil, Oca, anti‐Chido, anti‐Bg, 14 of 15 “nonspecific warm autoantibodies” (three of which were associated with the ingestion of alphamethyldopa), and four of five antibodies to high‐incidence antigens. Clinically significant antibodies included: anti‐Yta, anti‐Jkb, the antibody in PCH (with “P” specificity), one intensely hemolytic “nonspecific warm autoagglutinin,” and one of five incompletely characterized antibodies to high‐incidence antigens. An acceptable in vivo compatibility test in every instance was associated with an appropriate rise in hematocrit and no clinical symptoms of hemolytic transfusion reaction.
Nonhemolytic, IgG, anti-IT autoantibodies were found in the sera of three Caucasian patients, none of whom had Hodgkin's disease. Each antibody reacted by indirect antiglobulin test. Two of the three also reacted in albumin at 37 C, and one of these was moderately enhanced by papain. As judged by transfusion responses, reticulocyte counts, hematocrit stability, and one hour 51Cr red blood cell survivals, none of the antibodies were considered to be hemolytic. When tested with anti-IgG serum, cells from all three had a positive direct antiglobulin test. Anti-IT antibody was eluted from their cells. Ii status of the patients' cells differed from normal in each case. These data suggest greater variation in the disease association, serologic reactivity, and clinical significance, of anti-IT than has been evident from previous studies.
Three high frequency reactive antisera (Kir, Oca, M i l ) are described which, based on serologic and genetic characteristics, identify a set of apparently related antigens. The antibodies react only by indirect antiglobulin technique agitinst both adult and cord red blood cells, a r e > h a r i l y IgG, are not complement dependent nor enhanced by papain pretreatment of red blood cells, are high titered but of low avidity, and are not neutralized by serum nor absorbed by platelets. The antisera are not identical with, but may be related to, the Kn' antibody. Population data show reactivity frequencies of 99.8 per cent for Kir, 98.7 per cent for Oca, and 96.4 per cent forMil. The four phenotypes found are Kir+, Oca+, Mil+; Kir+, Oca+, Mil-; Kir+, Oca-, Mil+ and Kir-, Oca-, Mil-. The occurrence of five unrelated triple negative individuals is greater than would be expected by chance alone for three independent antigens. Family studies demonstrate that the triple negative phenotype appears to be a recessive trait not linked to the Fy or MNS loci, and the Mil-trait is not linked to ABO, Jk, or HLA. Clinical observations following infusion of incompatible blood and in vivo survival studies of "Cr tagged red blood cells indicate that the antigens, though potent immunogens, are no$ clinically significant. OVER THE PAST DECADE, blood bankershave encountered the problem of identifying several high incidence reactive antibodies, typically detectable only by indirect antiglobulin technique (ACT), of variable reactivity, low avidity and high titer.4-6.'2.'4.15,17 Over a six-month period, three antibodies of this type were encountered that identify a set of apparently related antigens. The present report characterizes these antibodies, demonstrates that they are not clinically significant and that they may be related to the Knops (Kna) and McCoy (McC') anti-b~d i e s .~.~~
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